title: Depression's moderation of the effectiveness of intensive case management with substance-dependent women on temporary assistance for needy families: outpatient substance use disorder treatment utilization and outcomes.
abstract: OBJECTIVE
  Intensive case management (ICM) is effective for facilitating entry into and retention in outpatient substance use disorder treatment (OSUDT) for low-income substance-dependent women; however, no studies have specifically examined the moderating impact of depressive symptoms on ICM. The purpose of this study was to investigate whether depressive symptoms moderated ICM's effect on OSUDT engagement, attendance, and outcomes for substance-dependent women on Temporary Assistance for Needy Families (TANF). It was hypothesized that highly depressed women would demonstrate worse outcomes on all indicators.
  
  
  METHODS
  Logistic regression and generalized estimating equations were used to determine depression's moderating impact on ICM in a secondary analysis of data from a randomized controlled trial comparing the effectiveness of ICM to usual care provided by local public assistance offices in Essex County, NJ. Substance-dependent women (N = 294) were recruited while being screened for TANF eligibility and were followed for 24 months.
  
  
  RESULTS
  Findings revealed that high levels of depressive symptoms moderated the effectiveness of ICM in unexpected directions for two outcome variables. Subjects with high levels of depressive symptoms in ICM were (a) significantly more likely to engage in at least one treatment program than those in usual care and (b) associated with the fewest mean drinks per drinking day across the 24-month follow-up period. Independent effects for high levels of depressive symptoms and ICM were also found to positively influence engagement, attendance, and percentage days abstinent.
  
  
  CONCLUSIONS
  ICM is effective for substance-dependent women with a broad spectrum of depressive symptoms in enhancing OSUDT utilization and outcomes.
authors.affiliation: Research Foundation for Mental Hygiene, Inc., Columbia Addiction Services and Psychotherapy Interventions Research, Columbia University, 3 Columbus Circle, New York, NY 10019, USA. Kuerbis@pi.cpmc.columbia.edu
authors.forename: Alexis N
authors.initials: AN
authors.lastname: Kuerbis
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Neighbors
authors.forename: Jon
authors.initials: J
authors.lastname: Morgenstern
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D019090:Case Management / Q000145:classification* / Q000191:economics / Q000458:organization & administration; D003863:Depression / Q000191:economics; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D004651:Employment / Q000191:economics / Q000523:psychology; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D010045:Outpatients; D010349:Patient Compliance; D011569:Psychiatric Status Rating Scales; D011632:Public Assistance / Q000191:economics / Q000706:statistics & numerical data; D012946:Social Welfare / Q000191:economics; D059039:Standard of Care; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult